Lawrence Davis, MD, MBA, FASTRO
Dr. Phillips: Could you tell us a little bit about where you were born and who your parents were and that kind of thing?
Dr. Davis: I was born in the suburb of Pittsburgh, North Braddock, Pennsylvania. It's a really depressed area now because the economy was maintained by US Steel, and US Steel pretty much closed up in the area. My father worked for the local pyrite company. He was a shop mechanic and my mother worked at Magee-Womens Hospital in the record room. And we lived in that area until I went off to college.
Dr. Phillips: What was your high school like?
Dr. Davis: It was not a big -- it was Scott High School. I guess we probably had maybe 150 in our class. Most of the people there didn't go on to college. It was an area that was primarily middle-class workers and I would guess, in our class, maybe a half a dozen went off to school. I had a scholarship. They gave senatorial scholarships in Pennsylvania which weren't worth a whole lot of money, and I had one and I was planning to go to the University of Pittsburgh. So I graduated second in my class. A young lady graduated first. She was in the commercial track.
Dr. Gibbs: So you ended up in Juniata College.
Dr. Davis: Yes, I did. And I'll tell you the way that happened. My home room teacher taught physics and he coached the basketball team. Juniata was in the middle of Pennsylvania and sort of in the shadow of Penn State. He was there recruiting basketball players, and since the coach knew me and I was in that class, he suggested that they were looking for somebody who was going to do academics and they should come and see me. They came and talked to my parents, and he convinced me that a small school would be better for me, rather than going to a big place like the University of Pittsburgh, and that they were generous in their scholarship support. They convinced me and my parents that it was the place to go. It was a good choice because that school only had about 150 in our class. It's bigger now and we had about a dozen people in pre-med and everybody got into medical school. They just had a very good reputation for getting people into medical school.
Dr. Gibbs: Did you play basketball as well?
Dr. Davis: I didn't do any sports at all. I was a non-sports person, since I was tall and had long legs. Everybody had to take some athletic kinds of things, and it varied with the season. The coach there wanted me to run hurdles. I didn't want to run hurdles because I was afraid they we're going to get wrapped around my legs. I never played much basketball. We had some intramural basketball. I could never dribble very well and I could shoot even less. And the pity was we were living on a golf course, and I thought it would have been nice in college to play golf. But that wasn't offered as an option. They had a golf team, but those people could play golf pretty decently. I never learned to swim, because at that time that college didn't have a swimming pool. And to some extent I'm frightened of the water because of it.
Dr. Phillips: What was your major at Juniata?
Dr. Davis: I started out in biology, but I did like chemistry, so I had a double major. There were a number of things that attracted me to chemistry. First of all, the person who taught general chemistry I liked, and I thought physical chemistry would really be great. But the person who taught physical chemistry thought physical chemistry was all about mathematics. The mathematics got a little bit over my head, so I struggled with that. But the rest of it was pretty good. On the other hand, it did soak up a lot of time, because there was a lot of lab time required in chemistry and biology. So I ended up graduating with a double major.
Dr. Gibbs: What are some of your most memorable experiences from college, like any activities or other things of that kind?
Dr. Davis: In the last year, I was editor of the yearbook, which was fun. And there was a fellow on campus who enjoyed going around taking pictures, and they had a dark room there, and I enjoyed doing that. The college was more than 100 miles from Pittsburgh up in the mountains of Pennsylvania, so that they used to have outings. They had one called Mountain Day where you would go out and tramp around in the woods. They had picnics outside, and the college was small enough so everybody pretty much knew each other and there weren't a lot of day students. The day students didn't get incorporated into the college activities since they would run in and out to take class. But it was really a very cordial place, and I enjoyed my roommates. I was very busy studying so I was never very social.
Dr. Gibbs: How did your interest in medicine come about?
Dr. Davis: Well, I think that part is interesting because from whenever I can remember, I wanted to be a doctor from the time I was a little youngster. The people in high school thought that was really a bad choice. They couldn't understand why I wanted to go into medicine. I was decent in science, so they thought one of the science routes would really be more to my liking. But since I can remember I always wanted to be a doctor. But on the other hand, I found going to a doctor really frightening, as a youngster. And we never went to the doctor much. You had to go to the doctor for your immunizations and things like that, and that scared me to death. But on the other hand, it just seemed like a great thing to do and nobody could quite understand it. That was what I wanted to do, and it worked out. I thought Juniata was a good choice for me because it was a small school and they looked after their students, and you weren't lost in a big crowd. And I did get into medical school.
Dr. Phillips: Did you pick Georgetown for medical school? Did you consider other options?
Dr. Davis: No. I picked Georgetown. I did apply to Harvard for early admission, and the advisor said it was a mistake applying for early admission. I applied to Harvard and I applied to Georgetown. I'm not sure I applied to many other schools, because I went to Georgetown for my interview. They offered me a position that my father was pretty convinced was the place for me to go. Most of the people in our class went to school in Philadelphia. A number went to Temple, several went to Penn. I thought the University of Pennsylvania probably was a better school and I never had anybody who was making the comparisons of the schools. My roommate went to Temple, one of my classmates went to the University of Pittsburgh. He eventually became a dean out in Colorado. So most of the people in the class were fairly successful coming from a small school. When I went to Georgetown, I had this passion to get finished with school, and I didn't know what the MD/PhD programs were about. If I had to do it over again, I probably would have applied for the MD/PhD track. The few people who went in that track had a PhD in biochemistry. I really liked chemistry so that would have worked for me, but I had this passion to be finished.
Dr. Gibbs: Did you do any research during that time?
Dr. Davis: No, none. The medical students had to do a clinical paper. We did a little case study about something or other. I don't even remember what it was. But I didn't do any research in medical school.
Dr. Phillips: Did you become interested in radiation oncology at that point or did that come later?
Dr. Davis: When I was in medical school I thought OB/GYN was really an attractive specialty. At Georgetown, you did your OB at the city hospital at DC General, and that was a nightmare of a rotation, because the medical students were on for 36 hours and then they were off for 12 hours. And the women were coming in at all times of the night. It was an area that served the poor people in the area. They came in without prenatal care and deliver their babies. I was up all hours of the night. You didn't get a whole lot of rest on that service. But that was not the worst part of it. All the medical students went to their Saturday classes. It was sort of their grand rounds of OB/GYN, and the chairman of OB/GYN thought the delightful part was embarrassing medical students. That was really a very uncomfortable Saturday morning, because he would ask them questions and none of the students had enough answers to satisfy him. It became a case that being in the conference was an embarrassment to medical students, and they tried to avoid getting called on. The embarrassment on the GYN part and the OB rotation discouraged me. When I was on pediatric, they had several times weekly where they would have sessions with the radiologists. They would show films and discuss cases and do differential diagnosis. I thought that was pretty interesting, so I was attracted to the imaging part of radiology. And at that time the specialties were not separated. It was pretty much general radiology. They were just starting to separate. The initial plan was that you couldn't have a separate program in diagnostic and therapy unless you had a general program. So I applied for the schools in Philadelphia. I applied to Jefferson, and I applied to the University of Pennsylvania. The University of Pennsylvania was my choice and they admitted me to that program. I started out my first year in diagnostic radiology. That program was four years, even though most programs were only three years. And the second year rotated on therapy. I decided I really did miss the patient contact. I talked about switching to straight therapy, and I found the fellow who was in charge of diagnostic radiology really frightening. When he found out I was going to switch, he lectured me on what a stupid decision that was and how I was going to end up my life starving, because people in therapy at that point didn't ever make any money. So I switched to straight therapy and finished. I had the one year of diagnostic radiology and then three years of therapy.
Dr. Phillips: Who were the mentors at that time in radiation oncology?
Dr. Davis: It was Rick Raventos who eventually went to UC Davis. Gene Pendergrass was retired, but he was still seeing an occasional patient. And Richard Chamberlain was the chairman. He did radiation therapy, although he thought he was a diagnostician. His interest was in radiation protection. He was on the international protection societies. I thought the training was decent. There were far better places, but when I got started I didn't know I was going to go into straight therapy. When I finished the program, I was deferred from the service through the Berry Program. I had to go in and serve two years, and when I finished my training I went into the Air Force. So the people who were deferred for radiology went off somewhere and read X-rays. I was able to get a research assignment. That's how I got to Bethesda. And to some extent, the person who helped me with that was Jim Brennan, who was still in the service at that time. He was the one who then eventually went up to Penn and started the neutron project.
Dr. Phillips: What were your duties at AFIP?
Dr. Davis: I was at AFRI -- the Armed Forces Radiobiology Institute.
Dr. Phillips: Oh, okay.
Dr. Davis: That was a tri-service place. And they had a reactor there, and the fellow who I worked with was a civilian whose PhD was in physiology. We worked out some research projects on animals looking at the effects of radiation on drugs. I had some experiments with rodents and some with monkeysm, in which they were then exposed to reactor radiation to see whether it altered their drug metabolism.
Dr. Phillips: They had a reactor there, didn't they?
Dr. Davis: Yeah, they did have a reactor there. And that was on the campus of the Navy Medical Center. So it was across the street from NIH. And I was able to go over and take some statistic classes at NIH.
Dr. Phillips: Who was the civilian scientist you were working with?
Dr. Davis: His name was Tom Strike.
Dr. Phillips: Oh, Tom Strike. Yes, I know him.
Dr. Davis: Yes. Eventually, he left there and went over and worked with Frank Mahoney in the radiation division at NCI.
Dr. Phillips: Were there any other radiation oncology people there at the same time?
Dr. Davis: No. Most of the other people were line officers. In our section there were two civilians, and there was an Army and a Navy person who were line officers. They weren't physicians. They had a few physicians, and they had a lot of non-physicians there. They had a number of line officers. The casual nature of the place drove the line officers crazy, because they were used to people saluting, and things like that. I was given a research assignment when I went in. I didn't have to go to boot camp, and, I guess, one of the regrets was I never knew how to fire a gun. I thought it would be nice to have had some training in guns. They're very big these days, but I had to do my yearly physical therapy -- fitness thing -- but I never had to do the other things in the service. I never had to go to boot camp. I went straight off there to Bethesda.
Dr. Phillips: Who were your co-residents when you were at Penn?
Dr. Davis: Bud Eaton. Do you know Bud?
Dr. Phillips: Yes, Bud.
Dr. Davis: Bud was the only one who did radiation oncology. He was ahead of me, maybe by a year or so. The other people were in diagnostic radiology. There was nobody else in that program who went into radiation oncology, because they were diagnostic guys. The program was not very big at that time. I think they took two or three residents a year. And at that time, it was general radiology programs people were applying for, because the programs were starting to separate.
Dr. Phillips: Right. I was a resident about that same time. Okay.
Dr. Gibbs: In terms of your initial faculty positions, it looks like you first were at Penn.
Dr. Davis: Yes. When I came out of the service, even before I went into the service, they had offered me a position at Penn. When I came out of the service I went to Penn.
Dr. Gibbs: Tell us about how that was in terms of advancing through the tenure or promotions process.
Dr. Davis: When I was there I was fortunate. I had a collection of publications in the service, but on the initial appointment was an instructor, so that bothered me a little bit. I did get some reasonably fast promotions to assistant professor and then associate professor. I was doing mostly patient care. That was really not a good time for Penn. Dick Chamberlain was still chairman. Things were not going so well. He was getting up in years and then his health got bad and toward the end of my time he died. There were a lot of question about what they were going to do when they recruited a new chairman. They recruited Stan for diagnostic radiology. He made the decision that they were going to separate off radiation therapy, and it was around that time that I was taking care of a lot of patients because I was one of the few people in the department. Bud Eaton had decided to go to Dartmouth. He had left because one of the surgeons had gone up to Dartmouth and persuaded Bud to go up there. It was initially the two of us taking care of the therapy load there. I don't remember how many patients we were treating, but I was essentially a busy clinician.
Dr. Gibbs: Those being all disease sites. I see some papers on lung, GI, lymphoma and neck. Did you treat all disease sites?
Dr. Davis: Oh, yes. Everything. People were not much specialized and the place was too small. John Curry, who was the department administrator at Jefferson with Simon Kramer, and that department had been separated for a long time. Phil was in charge of diagnostic radiology and Simon Kramer was in charge of radiation therapy, because that place had a very bad history with the person who was doing radiation oncology.
Dr. Phillips: At Jefferson, that is?
Dr. Davis: At Jefferson, right. They had fired the person, or he had left under very ugly circumstances, so it sort of dangled there and dangled there and they finally recruited Simon Kramer who was a little short of staff. John Curry persuaded him to talk to me about moving over to Jefferson. When I went there, they thought since I was a busy clinician at Penn that I would be a busy clinician at Jefferson. But my interest was not being a busy clinician. The clinical chair was Martha Southard. She had been recruited from Temple, and she had been there a good while. She really did idolize Simon Kramer and was very protective of him. But the problem was Simon Kramer had offered me a position where I would be part-time clinical and the rest of the time I would be working on the RTOG and the patterns of care study. Martha Southard couldn't figure out how somebody could be a part-time clinician. She thought that even if you had six patients, you had to be available 24/7. And that didn't work so well, because my office was not in the department. It was a block away, and that was before RTOG and the patterns of care study got separated off of Jefferson and moved into the College of Radiology. And then when it got moved in, it was in one of the Jefferson buildings. Then they moved to the College of Radiology and rented some space in one of the banks. It was equally close to Jefferson. But on the other hand, it was a little hard to take on new patients and treat them in the clinical environment at Jefferson.
Dr. Phillips: You were in on the start of RTOG and the patterns of care. Can you tell us a little bit more about how it was starting up those two activities and also the interaction with John Curry?
Dr. Davis: Yes. John Curry and I were really close in those days, because in his mind he was going to be the administrator and I was going to be the medical person in that office. And Simon was pretty busy over in the clinic. He really loved to take care of patients and patients loved him. It was my job to do the medical things related to RTOG. And at that time, the protocols were far fewer than they have now, so I did try to coordinate. I'd try to do the things that somebody in the chairman's office would do, with regard to a protocol development and assignments. And we started up the quality assurance stuff, we recruited some data managers. There were some nurses that I knew in the area who came on to do that. We ended up recruiting a dosimetrist. I had a hand in most of the initial staffing with regard to RTOG. The patterns of care was a little more of a struggle, because there was the constant struggle on how you were going to analyze that data. And to some extent they had a struggle with getting statisticians. When they did recruit some statisticians, I really did try to interact with them and tried to give them information on the medical side of it. In the time I was there, that office must have grown from about four people up to about 20 or 30 people. It got to be a really substantial organization, and they put all the computer stuff there. So I guess at that time the patterns of care study was looking at maybe five or six disease sites and developed the decision trees and things of that sort. I was helping with coordinating those meetings. In RTOG it was mostly related to protocol development and helping running the meetings. And I continued with that even after I left Jefferson -- not on the patterns of care side, but on the RTOG because there were medical things to review with the data managers. Even when I moved up to New York I used to spend a day a week in Philadelphia on the RTOG things and headquarters.
Dr. Gibbs: I noticed that you also studied for your MBA at that time. Were there things about the changes in practice patterns that prompted you to add this to your training?
Dr. Davis: I'll tell you what brought that about. I could see that I was more on the administrative side of medicine rather than the practicing side. I thought I did lack on administrative information. I thought it would be useful to have an MBA so that I could have a better sense of administration and management. Of course, the great school in Philadelphia is the Wharton School over at Penn, but that was a full-time program, and I couldn't possibly do a full-time program. Temple had a part-time program. They had some classes right in Center City where I could walk there. I had other classes up on campus which was a short subway ride, so I started that. And that was before MBAs were so fashionable for physicians. Now there are a lot of physicians getting MBAs. I think it taught me a discipline that was useful in managing, and it certainly was useful when I became a department chair because I had a background most department chairs didn't have, at that time.
Dr. Gibbs: And it looks like your next step then was moving to New York and eventually, I guess, becoming the chairman there.
Dr. Davis: Yes, I'll tell you how that happened. When Simon retired they had a search committee, I was one of the candidates. Carl Mansfield was Simon's first resident, and he had gone to Kansas. I was coming to the point where I thought, gee, what am I going to do in the future? And I thought the next step would be to try to be a chair of a department. And when they selected Carl to be chair at Jefferson, I think Carl was looking for a proper role for me, and that would have really worked out. I said to him that I really thought it was time to be a chairman, so Marv Rottman, in New York, encouraged me to apply for the position at Montefiore and Einstein, which I did. And so I got selected for that chairmanship and that was a tough place. New York is a tough place. The people are tough and Charlie Botstein was in charge there before I came on, and his style was totally different than mine.
Dr. Gibbs: In what way was Charlie Botstein’s style different from yours?
Dr. Davis: Well, to some extent I think he enjoyed disorganization. I thought it was interesting because they didn't even schedule patients for follow ups and consults. The notion was that they would go in and write their name, and if it took five minutes it was fine. If it took two hours, then one of the physicians said the patients all understand when it's your turn you're going to get your attention. But when it's not your turn, you're just going to sit there and wait. Well, I tried to get a little more organized. The machines were scheduled. On the other hand, the equipment was really old, and I think Charlie Botstein enjoyed being the teacher. You know, the rooster with all his chicks running around behind him. If he would come into the department, the people who were there before would be following him even if they had other things to do.
Dr. Gibbs: So he remained in the department after you became chair?
Dr. Davis: Not officially. Montefiore is on one side of the Bronx and Einstein is on the other side of the Bronx. Charlie Botstein would only appear in the department if he knew I wasn’t there, if I were over on the Einstein campus. And, of course, he and Harold -- I can't remember his name -- no, it was the fellow who was over on the Einstein side. That was a diagnostic radiologist. They basically hated each other. I mean, the Einstein people sort of hated the Montefiore people so that they were really functioning as two different units. The compromise eventually was that the Montefiore would run the hospitals and Einstein was basically the medical school. And one thing I didn't like about it up there was that the dean felt that the basic science people were his, but the clinic people belonged over at Montefiore or even at Einstein hospital, which was part of Montefiore then. The dean acted like they weren't really his. And so that was bothersome. I think one tough thing about New York is New Yorkers as people are tough. New York is a busy place. There are people everywhere and I think that they have learned to survive because they're not bashful. And then it came to a point where it was sort of a tough thing to build that department because over on the Montefiore side they had a betatron which was non-functioning, and Charlie Botstein thought the betatrons were the most wonderful thing in the world. The accelerators were starting to replace the betatrons, even though at Jefferson there was a betatron. And so when I went up there, they had promised to replace some of the equipment. When I decided that we were going to get a linear accelerator to replace that betatron, Charlie Botstein made as much noise as he could about it, because he thought that was absolutely the wrong thing to do.
Dr. Gibbs: This is quite interesting.
Dr. Davis: But eventually that got replaced, and then we replaced two other accelerators. The rooms were incredibly small. There was not a lot of space up there, and then over on the Einstein side we replaced two machines. And the thing is over on the Einstein side. Before I came, those were two separate entities, and that made it one when I came up there. The fellow who was in charge over on the Einstein side went into private practice down in Manhattan. Gosein was his name. But there was a community hospital a mile and a half from Einstein where he maintained privileges, and they had a treatment machine. He was a real competitor on that side. Building that practice was always sort of a struggle. On the Montefiore side it was a little different. And there were two city hospitals that were part of that, too. Neither city hospital had radiation therapy equipment. North Central Bronx is attached to Montefiore. So if you had people in that hospital you were treating, that was easy. The one over on the Einstein side was across the street so that if there were hospital patients that you needed to see, it was a really long walk over there. And as I say, there were sort of continuing hostilities historically between those two. But we did put it together. They had a residency program that got shaped up when I went up there. The few residents they had in there were Russian immigrants, and we finally did sort of get that going very slowly.
Dr. Gibbs: It sounds like there were some strides made in a positive direction, during your tenure at Albert Einstein.
Dr. Davis: There was no doubt about it -- Einstein and Montefiore. We re-equipped it. And New York is a very regulated state on equipment, and they lost out on all the good financing because of their regulations. It was really hard to get equipment when Medicare would pay for it. And when they loosened their restrictions, Medicare wouldn't pay for it anymore. So if you wanted equipment, it was a real struggle because everything was hospital-based. And I do remember MRs were sort of coming in then, and they had one MR and it was a big deal. They had a new MR and I remember the fellow who was president of the hospital, the MR was busy -- you know? -- and you had to wait a while to get an appointment and he said there's no point in putting in another one because that was just going to cost money and people would still want more. So as a result, places were springing up around with imaging centers. But it was really tough to get anything in the hospital. And their attitude was that the in-patients made the money, and if radiation oncology didn't have much of an in-patient service, they were going to suffer when they had to do budget cuts. It didn't matter if you were busy with out-patients. Their view was the in-patient service was what made the money.
Dr. Phillips: What got you interested in going to Emory?
Dr. Davis: I always wanted to move south. We got tired of the cold weather up north, both Sally and I, and I had looked at Emory earlier. They had opened a search years before, and I went down and I was interviewed there. I really did have a real interest in moving south. I looked at a couple of positions and looked at one at the Medical College of Georgia and at Emory. And I thought there was a real opportunity at Emory. And when the dean offered me the position it was the best move I could have made because coming from New York, when I went down there and I saw radiology, they were crying that they didn't have enough equipment. But compared to New York they had a ton of equipment. They had four MRs, and they must have had four CT scanners and a bright shiny place. On the other hand, it was a strange situation because the practice was freestanding.
Dr. Phillips: The equipment was all freestanding also?
Dr. Davis: Yes. It's right there in the Emory Clinic, but the practice was freestanding and so we were total billers. And the attitude, at that time, was if you want a piece of equipment and you can pay for it, you buy it. The fellow in charge of the Emory Clinic said to me that they ran on a calendar year, and at the end of the calendar year they closed the books and any money in there had to be distributed. The few people down there like John McClaren were really making quite a bit of money. And they were going through the transition. They wanted the place to be more academic, but on the other hand they had these people there before under that policy. As long as I was chairman radiation oncology was considered freestanding.
Dr. Phillips: The hospital got none of the income.
Dr. Davis: No. None at all. None of the equipment was in the hospital. It's all over in the Emory Clinic which is attached to the hospital; you walk there through the tunnel or the bridge. You walk into the hospital, but nothing equipment-wise in radiation oncology is in the hospital.
Dr. Phillips: Was that the case at Penn early in the '60s? Did Pendergrass own all the equipment?
Dr. Davis: He did own the equipment, but I think by the time Dick Chamberlain took it over, I don't think that was the case. I think they had to strike some kind of deal where the hospital took it back. But I think that was the arrangement up there. I was never really privy much to the finances up at Penn.
Dr. Phillips: Did it eventually evolve into the hospital taking it over while you were at Emory?
Dr. Davis: I don't know. Now that Wally Curran is there, he struck some kind of deal because I think the hospital has taken over radiology pretty much, but radiation oncology was still separate. And I thought what Wally did to stave them off was to do some income sharing with them. But on the other hand, they have to do some equipment sharing on the purchases. I mean, it did come to the point even though it was still freestanding and we were earning that money, they sort of reorganized the place so that the fellow who was the chief financial officer for the hospital became the chief financial officer for the Emory Clinic, too. His view was if you couldn't justify a piece of equipment on the basis of a business plan, you couldn't buy it, even if you had money in the bank, because the Emory Clinic got into some financial troubles. Radiation oncology didn't because the money in radiation oncology was basically supporting the credit of the whole Emory Clinic. The financial officer was of the opinion you couldn't spend that money because they needed it for their credit. So while radiation oncology had the money in the bank, he wouldn't let you spend it. So you had to justify the equipment on the basis of the business plan. It got to be hard. If we wanted a new piece of equipment because it did IMRT and we said it would be better treatment, he didn't care whether it would be better treatment. He only cared dollars-and-cents-wise. But on the other hand if they would approve it, then you had to pay for it. You had to pay for it out of the department funds. That arrangement has changed some, but it still is sort of a unique situation.
Dr. Phillips: Well, Larry, could you tell us a little bit now about your involvement at the American Board of Radiology and the American College of Radiology? You have important positions there and contributed a lot. I wonder if you could tell us a little bit about that?
Dr. Davis: I got to be a trustee of the Board or Radiology, I think through the help of Simon Kramer. The Board of Radiology had six radiation oncology trustees. Three are nominated by ASTRO and three are nominated by the American Radium Society. Simon was president of the American Radium Society, and I did chat with him about my interest in becoming a member of the board. He had to send forward three nominees and then the trustees vote on the people who have been nominated. The cycle before, Bill Powers, I and somebody else were nominated. I didn't think Bill Powers was interested. At that point Bill was at Jefferson and he had an office right across the space from me, because we were both working on Patterns of Care. And Bill got elected and that shocked me, because I didn't know he was interested. On the other hand, the trustees on the Board of Radiology were Luther Brady, Sy Levitt, Juan del Regato, Bob Parker and Norah Tapley. Norah was given the assignment to tell me that I didn't get elected to the board. About a year or so later, Norah died and that opened up another spot, so Simon had me nominated again from the Radium Society. And since he saw how it worked, he had two other people nominated along with me that he didn't think were going to be acceptable to Luther Brady. Then they found me as the most acceptable of the candidates, so I got elected to the Board. Now at that time the Board's view was that you would examine not in your area of interest. So I was interested in head and neck tumors. They won't let you examine in your area of interest. Most of the job was the oral examination and, to some extent, helping to create the written exam. Terms on the Board at that time were six years, and you were eligible to be reelected once. I had the unexpired term of Norah Tapley to fill, which was about two years yet. And then I got elected for two terms of my own. And I enjoyed being with the Board, and it got bigger as time went on, because the Board got into more things. There was a lot of unhappy politicking within the Board, and some of that came about. The problem Sy Levitt had with the Board and how Luther approached that on trying to get that solved. And they had one assistant director. That was when Ken Kravanaugh was the executive director and he wanted to work with Jerry White. So for a long time Jerry White was the assistant executive director, and that went on for years. At some point -- and I think that was when Bob Parker was president of the board -- there was enough noise that radiation oncology was so separate from diagnostic radiology that they should have an assistant executive director for radiation oncology. And so I was proposed for that role right around the time my second full term was finishing. I got appointed for that. I mean, they had interviews and there might have been some other candidates, but I don't truthfully remember who they were.
Dr. Phillips: That's when the Board moved to Tucson?
Dr. Davis: Yes, the Board had already moved to Tucson. The Board got moved to Tucson because of Paul Capp. The Board had been moved, and Jerry White was still assistant executive director because they moved when Paul Capp replaced Ken Kravanaugh. I was doing things with regard to the Board, but Paul was never convinced that he couldn't do all the radiation oncology stuff, too. It came to the point that Bob Parker pushed it and Lester Peters, too. They decided that they would separate the administrative functions with two assistant executive directors. And while Paul was not pleased with it, he wasn't unaccepting of it either. I got appointed in that position, and I picked that up when I finished my second full term. I did some of it while I was still a trustee, and that had to do with the administrative things that the Board does now. Most of that could be done from my office. I didn't have to go to Tucson to do it because, in fact, after Bob Hattery took over the Board, he really felt I needed to come to Tucson quarterly, but there wasn't a lot to do. What I tried to do was to gather up the stuff that I would do in my office at Emory and do it in Tucson instead. It was a lot to review the written exam and to look at the material that they were getting for the oral exam. Those tended to be the kind of paperwork, reviewing all the applications for the examination. I continued that up until a couple years ago when my final term was up, because Steve Leibel was the one who negotiated the contract that ran until I left the Board. It didn't pay anything at all. I did it mostly because I thought it was important to do. Then they paid a little bit. We estimated that I was spending one day a week on the Board so it was sort of one-fifth of what they would pay for a visiting person at the Board office.
Dr. Gibbs: You had an impressive 30 years of commitment to the ABR.
Dr. Davis: It was a lot of time, because I even forgot how long I was there. When I stepped down, they gave me a little memento. That was 30 years. I thought, wow, that time went by quickly.
Dr. Gibbs: Well, good.
Dr. Phillips: Time goes fast when you're having fun.
Dr. Davis: Yes it does. It’s interesting because I was never quite so committed to the college. I worked in the college office all the years I was at Jefferson, and some afterwards.
Dr. Phillips: You got the Gold Medal from the college also.
Dr. Davis: Yes. I think that was interesting and I have to credit Steve Leibel for that, because in my mind I did far more for ASTRO than I ever did for the college, but I didn't get a Gold Medal from ASTRO. For the college, Steve wrote to Peter Johnstone at the place and said Larry needs the Gold Medal from the college. Would you nominate him? They nominated me, and Steve was on the board of the chancellors at the time. My guess would be maybe behind the scenes he orchestrated that, because I was shocked when I got that Gold Medal. Now I routinely go to the college meeting in May for the Gold Medal dinner. And I was on the board of chancellors for six years and I was on other committees for the college, too. And a lot of that for me was really boring because it was all diagnostic radiology, and diagnostic radiologists are all talking about diagnostic stuff, their billings and their politics. And radiation oncology was such a small part of it that there were times I had trouble staying awake in those meetings, even when I was on the board of chancellors. I never felt I was much of a contributor to it, because I didn't have a lot of interest in the issues of the diagnostic guys. I always felt we really should be far more separate, and the college was trying to keep it all together. And when I was on the board of chancellors, Frank Wilson was on. Frank was really a big pusher. We're one specialty and we need to be together, and he'd encourage college membership and I was never much onboard with that. I thought ASTRO should do it all, and I think ASTRO is pretty much doing it all now. I thought that was the appropriate thing. I thought that's what the radiation oncology community wanted. They didn't necessarily want the college to do it.
Dr. Phillips: Well, getting to your role in ASTRO, what were the most important things that came up while you were president and chairman of the board in terms of the development of ASTRO?
Dr. Davis: Well, I think there were two things. First of all, the finances were in real bad shape with ASTRO, and they've really turned that around. The second thing is that the meeting was getting bigger, and the year I was president was the last year that the meeting was in a hotel. We made the transition to the convention center. I thought those were two very positive moves. ASTRO wasn't into all these other things that they are in now. They weren't doing the lobbying or anything else like that, but that wasn't even on the agenda. ASTRO was small enough then, at least financially, that they couldn't nearly afford the staff. Things were pretty much being run by the college. The meeting-planning people were over there. ASTRO was just the annual meeting at that time.
Dr. Phillips: Do you think the direction that ASTRO has taken is good?
Dr. Davis: I think it is absolutely good because, radiation-oncology-wise, I think those people think of ASTRO as their organization. They are doing all these other meetings. I can't comment about those. I think it's probably the right thing to do. I think that's what the members want. And I've always had sort of a soft spot in my heart for the Radium Society. I thought it was a good meeting. It was small and, to some extent, I think they're getting squeezed out, but that's a different issue. But I think ASTRO is going in the right direction. And I see there are some proponents now. I see Anthony Zietman says that we need to be closer to diagnostic radiology. Well, maybe. See, I think it was interesting before. I do remember Doug Maynard who was chair at Bowman Gray. As far as he was concerned, radiation oncologists need some protection from the diagnostic radiologists. I never was of that view, but I think there was a view that the medical oncologists are going to gobble you up. But I think other specialties are after us, and I think ASTRO is the logical organization to try to stave that off.
Dr. Gibbs: I wanted to switch gears a little bit and talk about your family life. You had mentioned, I think, your wife Sally. When did you meet and under what circumstances?
Dr. Davis: Yes. This is my second marriage, and Sally worked for the College of Radiology. That's where I met her in Philadelphia. She is a Philadelphian, a long-time Philadelphian, and, to some extent, her heart is still in Philadelphia. While I was born and raised in Pittsburgh, my heart is in Atlanta now. I feel very much rooted here in Atlanta, but she still has a soft spot in her heart for Philadelphia. By her previous marriage, she has three children. Her daughter and one son have no children, and the other son has three children -- two boys and a girl. And they just graduated from college, and one is still in high school. I have a daughter who was in Florida. She’s married to a dermatologist, and she has triplets that are 16. But she's coming to the point that she has to worry about where they're going to go to school when they get out of high school. I'm glad I don't have to do that anymore.
Dr. Gibbs: You mentioned that Atlanta has been the area that you are really rooted and grounded in now. Are there particular hobbies that you enjoy?
Dr. Davis: I like baseball. I wish the Braves would do better. I still like football, but I like the Pittsburgh Steelers. I don't follow the Falcons even though they did pretty well, not as well as San Francisco, but they did pretty well. And we live on a golf course. I'd like to learn to play golf. I do go out, but everything is a practice round for me. There are things that occupy my time. If I go out on the golf course, I like to get the first tee time, so I won’t be held up by people in front of me, and I don't like people behind me either. I just like to go out and have a little fun. So I'll probably start doing that again. And we have tickets to the Atlanta Symphony. I like that, too. I like the classical music. I like opera, too, and the Atlanta opera is okay. Sally isn't so taken with opera. When we were up in New York, we had tickets for the Met and she thought that the best part of that was the dinner that went with the opera. There are certain operas I like, but I don't have a broad taste in that. And we both like ballet. Ballet in Atlanta is not so great. And for a long time even after we left New York, we had tickets to the New York City Ballet and the American Ballet Theater. But we got tired of running up to New York for the ballet, so we've sort of given that up. I think in the South the better ballet is in Miami. But that's not such an easy trek either.
Dr. Phillips: Did you ever do Sabbaticals, Larry, or visiting professorships that were memorable?
Dr. Davis: No. Never did a Sabbatical. A Sabbatical was not part of the opportunity down here. And I never did a lot of teaching, so I didn't do much in the way of visiting professorships. I got caught up with other things. I got caught up with building the department. At Emory I was caught up with the Board of Radiology, and I let the academics slide. Which was a pity. When I retired, I was probably one of the busier practitioners in the department. I was doing head, neck and breast. And since then, Emory head and neck is really a very good service, and we recruited somebody who fits right in with that group and is doing well.
Dr. Phillips: Do you have any reflections on your career? Anything you would have rather done differently than what you did do?
Dr. Davis: Yes. If I wasn't in such a panic to get on with my education, I would have done an MD/PhD program. I do have regrets about that. It would have been nice to do a PhD because I think it gives you discipline in your thinking and discipline in your research. It probably would have gotten me more caught up in publications and writing, things of that sort. Because I always looked on writing as being a real chore, so I didn't write so much. And I don't know that it would have helped me with the notion of teaching. If I had it to do over again, I might have made some other choices coming out of medical school of where I would have done my training. But if that had happened, I wouldn't have gone into radiation oncology and I think that was the right choice. I guess the only thing is really the PhD thing.
Dr. Gibbs: Since you've really navigated a number of situations, sometimes not entering them under rosy circumstances. In some situations you were able to affect some degree of change during your time, whether it be on the board or whether as a chairman. If you were to speak to an incoming department chairman now, what insights or leadership principles would you share with them?
Dr. Davis: I would tell them that you can't be very dogmatic. I think you have to look around and identify how you get the job done and establish relationships with people at the institution that are going to help you do that. I remember one time way back when I was a young puppy, I was at a cocktail party for one of the organizations, and Luther Brady was there. He said if you get involved with an organization, you have to look around and see how people move up in the organization. Then you need to work at that. I guess that is good advice. You can't just hop in and say I'm just going to do things. You need to take a minute and look around, see how the organization works and see how you're going to have the biggest influence with people and getting your job done by volunteering for things that they find useful. Down at Emory I got along very well with the financial people and the administrative people who helped me find space. The department was successful financially, so I was able to establish four endowed chairs in the department. In fact, the chair that Wally Curran occupies is named for me. The medical school had my name put on it with the consent of the department so that he's in that. There's a clinical endowed chair, a physics endowed chair and a biology endowed chair, because Mike Johns, who was the vice president for health affairs, said you need to put money aside to take care of the future of the department. And we had started doing that, and the fact that he endorsed that meant that the finance people in the Emory Clinic would let us move money over into the medical school where we could establish those endowed chairs. So I thought that was good advice.
Dr. Phillips: Do you have any favorite sayings?
Dr. Davis: No. Sorry, I wish I did. I'm a reader. I'm not a reader of good literature. I'm a reader of the fiction on The New York Times Best Seller List because it is a total distraction. On the one hand, it doesn't have all these wonderful sayings that the real literature does which Sally reads. She likes to read things that are more literature.
Dr. Gibbs: What would you say is your most important accomplishment that you're most proud of?
Dr. Davis: I think building the department at Emory. I was the first chair. They created the department when I came, and I think building that department is the thing I'm most proud of. I built the department, recruited the clinical staff, the physics staff, the biology staff. We established the residency program. It's one of the bigger programs now. They're approved for 16 residents. So I think I look on that as my accomplishment.
Dr. Phillips: Well, Larry, thank you so much. It's been a great interview.
Dr. Davis: Thank you for thinking of me to do it.
Dr. Davis: I was born in the suburb of Pittsburgh, North Braddock, Pennsylvania. It's a really depressed area now because the economy was maintained by US Steel, and US Steel pretty much closed up in the area. My father worked for the local pyrite company. He was a shop mechanic and my mother worked at Magee-Womens Hospital in the record room. And we lived in that area until I went off to college.
Dr. Phillips: What was your high school like?
Dr. Davis: It was not a big -- it was Scott High School. I guess we probably had maybe 150 in our class. Most of the people there didn't go on to college. It was an area that was primarily middle-class workers and I would guess, in our class, maybe a half a dozen went off to school. I had a scholarship. They gave senatorial scholarships in Pennsylvania which weren't worth a whole lot of money, and I had one and I was planning to go to the University of Pittsburgh. So I graduated second in my class. A young lady graduated first. She was in the commercial track.
Dr. Gibbs: So you ended up in Juniata College.
Dr. Davis: Yes, I did. And I'll tell you the way that happened. My home room teacher taught physics and he coached the basketball team. Juniata was in the middle of Pennsylvania and sort of in the shadow of Penn State. He was there recruiting basketball players, and since the coach knew me and I was in that class, he suggested that they were looking for somebody who was going to do academics and they should come and see me. They came and talked to my parents, and he convinced me that a small school would be better for me, rather than going to a big place like the University of Pittsburgh, and that they were generous in their scholarship support. They convinced me and my parents that it was the place to go. It was a good choice because that school only had about 150 in our class. It's bigger now and we had about a dozen people in pre-med and everybody got into medical school. They just had a very good reputation for getting people into medical school.
Dr. Gibbs: Did you play basketball as well?
Dr. Davis: I didn't do any sports at all. I was a non-sports person, since I was tall and had long legs. Everybody had to take some athletic kinds of things, and it varied with the season. The coach there wanted me to run hurdles. I didn't want to run hurdles because I was afraid they we're going to get wrapped around my legs. I never played much basketball. We had some intramural basketball. I could never dribble very well and I could shoot even less. And the pity was we were living on a golf course, and I thought it would have been nice in college to play golf. But that wasn't offered as an option. They had a golf team, but those people could play golf pretty decently. I never learned to swim, because at that time that college didn't have a swimming pool. And to some extent I'm frightened of the water because of it.
Dr. Phillips: What was your major at Juniata?
Dr. Davis: I started out in biology, but I did like chemistry, so I had a double major. There were a number of things that attracted me to chemistry. First of all, the person who taught general chemistry I liked, and I thought physical chemistry would really be great. But the person who taught physical chemistry thought physical chemistry was all about mathematics. The mathematics got a little bit over my head, so I struggled with that. But the rest of it was pretty good. On the other hand, it did soak up a lot of time, because there was a lot of lab time required in chemistry and biology. So I ended up graduating with a double major.
Dr. Gibbs: What are some of your most memorable experiences from college, like any activities or other things of that kind?
Dr. Davis: In the last year, I was editor of the yearbook, which was fun. And there was a fellow on campus who enjoyed going around taking pictures, and they had a dark room there, and I enjoyed doing that. The college was more than 100 miles from Pittsburgh up in the mountains of Pennsylvania, so that they used to have outings. They had one called Mountain Day where you would go out and tramp around in the woods. They had picnics outside, and the college was small enough so everybody pretty much knew each other and there weren't a lot of day students. The day students didn't get incorporated into the college activities since they would run in and out to take class. But it was really a very cordial place, and I enjoyed my roommates. I was very busy studying so I was never very social.
Dr. Gibbs: How did your interest in medicine come about?
Dr. Davis: Well, I think that part is interesting because from whenever I can remember, I wanted to be a doctor from the time I was a little youngster. The people in high school thought that was really a bad choice. They couldn't understand why I wanted to go into medicine. I was decent in science, so they thought one of the science routes would really be more to my liking. But since I can remember I always wanted to be a doctor. But on the other hand, I found going to a doctor really frightening, as a youngster. And we never went to the doctor much. You had to go to the doctor for your immunizations and things like that, and that scared me to death. But on the other hand, it just seemed like a great thing to do and nobody could quite understand it. That was what I wanted to do, and it worked out. I thought Juniata was a good choice for me because it was a small school and they looked after their students, and you weren't lost in a big crowd. And I did get into medical school.
Dr. Phillips: Did you pick Georgetown for medical school? Did you consider other options?
Dr. Davis: No. I picked Georgetown. I did apply to Harvard for early admission, and the advisor said it was a mistake applying for early admission. I applied to Harvard and I applied to Georgetown. I'm not sure I applied to many other schools, because I went to Georgetown for my interview. They offered me a position that my father was pretty convinced was the place for me to go. Most of the people in our class went to school in Philadelphia. A number went to Temple, several went to Penn. I thought the University of Pennsylvania probably was a better school and I never had anybody who was making the comparisons of the schools. My roommate went to Temple, one of my classmates went to the University of Pittsburgh. He eventually became a dean out in Colorado. So most of the people in the class were fairly successful coming from a small school. When I went to Georgetown, I had this passion to get finished with school, and I didn't know what the MD/PhD programs were about. If I had to do it over again, I probably would have applied for the MD/PhD track. The few people who went in that track had a PhD in biochemistry. I really liked chemistry so that would have worked for me, but I had this passion to be finished.
Dr. Gibbs: Did you do any research during that time?
Dr. Davis: No, none. The medical students had to do a clinical paper. We did a little case study about something or other. I don't even remember what it was. But I didn't do any research in medical school.
Dr. Phillips: Did you become interested in radiation oncology at that point or did that come later?
Dr. Davis: When I was in medical school I thought OB/GYN was really an attractive specialty. At Georgetown, you did your OB at the city hospital at DC General, and that was a nightmare of a rotation, because the medical students were on for 36 hours and then they were off for 12 hours. And the women were coming in at all times of the night. It was an area that served the poor people in the area. They came in without prenatal care and deliver their babies. I was up all hours of the night. You didn't get a whole lot of rest on that service. But that was not the worst part of it. All the medical students went to their Saturday classes. It was sort of their grand rounds of OB/GYN, and the chairman of OB/GYN thought the delightful part was embarrassing medical students. That was really a very uncomfortable Saturday morning, because he would ask them questions and none of the students had enough answers to satisfy him. It became a case that being in the conference was an embarrassment to medical students, and they tried to avoid getting called on. The embarrassment on the GYN part and the OB rotation discouraged me. When I was on pediatric, they had several times weekly where they would have sessions with the radiologists. They would show films and discuss cases and do differential diagnosis. I thought that was pretty interesting, so I was attracted to the imaging part of radiology. And at that time the specialties were not separated. It was pretty much general radiology. They were just starting to separate. The initial plan was that you couldn't have a separate program in diagnostic and therapy unless you had a general program. So I applied for the schools in Philadelphia. I applied to Jefferson, and I applied to the University of Pennsylvania. The University of Pennsylvania was my choice and they admitted me to that program. I started out my first year in diagnostic radiology. That program was four years, even though most programs were only three years. And the second year rotated on therapy. I decided I really did miss the patient contact. I talked about switching to straight therapy, and I found the fellow who was in charge of diagnostic radiology really frightening. When he found out I was going to switch, he lectured me on what a stupid decision that was and how I was going to end up my life starving, because people in therapy at that point didn't ever make any money. So I switched to straight therapy and finished. I had the one year of diagnostic radiology and then three years of therapy.
Dr. Phillips: Who were the mentors at that time in radiation oncology?
Dr. Davis: It was Rick Raventos who eventually went to UC Davis. Gene Pendergrass was retired, but he was still seeing an occasional patient. And Richard Chamberlain was the chairman. He did radiation therapy, although he thought he was a diagnostician. His interest was in radiation protection. He was on the international protection societies. I thought the training was decent. There were far better places, but when I got started I didn't know I was going to go into straight therapy. When I finished the program, I was deferred from the service through the Berry Program. I had to go in and serve two years, and when I finished my training I went into the Air Force. So the people who were deferred for radiology went off somewhere and read X-rays. I was able to get a research assignment. That's how I got to Bethesda. And to some extent, the person who helped me with that was Jim Brennan, who was still in the service at that time. He was the one who then eventually went up to Penn and started the neutron project.
Dr. Phillips: What were your duties at AFIP?
Dr. Davis: I was at AFRI -- the Armed Forces Radiobiology Institute.
Dr. Phillips: Oh, okay.
Dr. Davis: That was a tri-service place. And they had a reactor there, and the fellow who I worked with was a civilian whose PhD was in physiology. We worked out some research projects on animals looking at the effects of radiation on drugs. I had some experiments with rodents and some with monkeysm, in which they were then exposed to reactor radiation to see whether it altered their drug metabolism.
Dr. Phillips: They had a reactor there, didn't they?
Dr. Davis: Yeah, they did have a reactor there. And that was on the campus of the Navy Medical Center. So it was across the street from NIH. And I was able to go over and take some statistic classes at NIH.
Dr. Phillips: Who was the civilian scientist you were working with?
Dr. Davis: His name was Tom Strike.
Dr. Phillips: Oh, Tom Strike. Yes, I know him.
Dr. Davis: Yes. Eventually, he left there and went over and worked with Frank Mahoney in the radiation division at NCI.
Dr. Phillips: Were there any other radiation oncology people there at the same time?
Dr. Davis: No. Most of the other people were line officers. In our section there were two civilians, and there was an Army and a Navy person who were line officers. They weren't physicians. They had a few physicians, and they had a lot of non-physicians there. They had a number of line officers. The casual nature of the place drove the line officers crazy, because they were used to people saluting, and things like that. I was given a research assignment when I went in. I didn't have to go to boot camp, and, I guess, one of the regrets was I never knew how to fire a gun. I thought it would be nice to have had some training in guns. They're very big these days, but I had to do my yearly physical therapy -- fitness thing -- but I never had to do the other things in the service. I never had to go to boot camp. I went straight off there to Bethesda.
Dr. Phillips: Who were your co-residents when you were at Penn?
Dr. Davis: Bud Eaton. Do you know Bud?
Dr. Phillips: Yes, Bud.
Dr. Davis: Bud was the only one who did radiation oncology. He was ahead of me, maybe by a year or so. The other people were in diagnostic radiology. There was nobody else in that program who went into radiation oncology, because they were diagnostic guys. The program was not very big at that time. I think they took two or three residents a year. And at that time, it was general radiology programs people were applying for, because the programs were starting to separate.
Dr. Phillips: Right. I was a resident about that same time. Okay.
Dr. Gibbs: In terms of your initial faculty positions, it looks like you first were at Penn.
Dr. Davis: Yes. When I came out of the service, even before I went into the service, they had offered me a position at Penn. When I came out of the service I went to Penn.
Dr. Gibbs: Tell us about how that was in terms of advancing through the tenure or promotions process.
Dr. Davis: When I was there I was fortunate. I had a collection of publications in the service, but on the initial appointment was an instructor, so that bothered me a little bit. I did get some reasonably fast promotions to assistant professor and then associate professor. I was doing mostly patient care. That was really not a good time for Penn. Dick Chamberlain was still chairman. Things were not going so well. He was getting up in years and then his health got bad and toward the end of my time he died. There were a lot of question about what they were going to do when they recruited a new chairman. They recruited Stan for diagnostic radiology. He made the decision that they were going to separate off radiation therapy, and it was around that time that I was taking care of a lot of patients because I was one of the few people in the department. Bud Eaton had decided to go to Dartmouth. He had left because one of the surgeons had gone up to Dartmouth and persuaded Bud to go up there. It was initially the two of us taking care of the therapy load there. I don't remember how many patients we were treating, but I was essentially a busy clinician.
Dr. Gibbs: Those being all disease sites. I see some papers on lung, GI, lymphoma and neck. Did you treat all disease sites?
Dr. Davis: Oh, yes. Everything. People were not much specialized and the place was too small. John Curry, who was the department administrator at Jefferson with Simon Kramer, and that department had been separated for a long time. Phil was in charge of diagnostic radiology and Simon Kramer was in charge of radiation therapy, because that place had a very bad history with the person who was doing radiation oncology.
Dr. Phillips: At Jefferson, that is?
Dr. Davis: At Jefferson, right. They had fired the person, or he had left under very ugly circumstances, so it sort of dangled there and dangled there and they finally recruited Simon Kramer who was a little short of staff. John Curry persuaded him to talk to me about moving over to Jefferson. When I went there, they thought since I was a busy clinician at Penn that I would be a busy clinician at Jefferson. But my interest was not being a busy clinician. The clinical chair was Martha Southard. She had been recruited from Temple, and she had been there a good while. She really did idolize Simon Kramer and was very protective of him. But the problem was Simon Kramer had offered me a position where I would be part-time clinical and the rest of the time I would be working on the RTOG and the patterns of care study. Martha Southard couldn't figure out how somebody could be a part-time clinician. She thought that even if you had six patients, you had to be available 24/7. And that didn't work so well, because my office was not in the department. It was a block away, and that was before RTOG and the patterns of care study got separated off of Jefferson and moved into the College of Radiology. And then when it got moved in, it was in one of the Jefferson buildings. Then they moved to the College of Radiology and rented some space in one of the banks. It was equally close to Jefferson. But on the other hand, it was a little hard to take on new patients and treat them in the clinical environment at Jefferson.
Dr. Phillips: You were in on the start of RTOG and the patterns of care. Can you tell us a little bit more about how it was starting up those two activities and also the interaction with John Curry?
Dr. Davis: Yes. John Curry and I were really close in those days, because in his mind he was going to be the administrator and I was going to be the medical person in that office. And Simon was pretty busy over in the clinic. He really loved to take care of patients and patients loved him. It was my job to do the medical things related to RTOG. And at that time, the protocols were far fewer than they have now, so I did try to coordinate. I'd try to do the things that somebody in the chairman's office would do, with regard to a protocol development and assignments. And we started up the quality assurance stuff, we recruited some data managers. There were some nurses that I knew in the area who came on to do that. We ended up recruiting a dosimetrist. I had a hand in most of the initial staffing with regard to RTOG. The patterns of care was a little more of a struggle, because there was the constant struggle on how you were going to analyze that data. And to some extent they had a struggle with getting statisticians. When they did recruit some statisticians, I really did try to interact with them and tried to give them information on the medical side of it. In the time I was there, that office must have grown from about four people up to about 20 or 30 people. It got to be a really substantial organization, and they put all the computer stuff there. So I guess at that time the patterns of care study was looking at maybe five or six disease sites and developed the decision trees and things of that sort. I was helping with coordinating those meetings. In RTOG it was mostly related to protocol development and helping running the meetings. And I continued with that even after I left Jefferson -- not on the patterns of care side, but on the RTOG because there were medical things to review with the data managers. Even when I moved up to New York I used to spend a day a week in Philadelphia on the RTOG things and headquarters.
Dr. Gibbs: I noticed that you also studied for your MBA at that time. Were there things about the changes in practice patterns that prompted you to add this to your training?
Dr. Davis: I'll tell you what brought that about. I could see that I was more on the administrative side of medicine rather than the practicing side. I thought I did lack on administrative information. I thought it would be useful to have an MBA so that I could have a better sense of administration and management. Of course, the great school in Philadelphia is the Wharton School over at Penn, but that was a full-time program, and I couldn't possibly do a full-time program. Temple had a part-time program. They had some classes right in Center City where I could walk there. I had other classes up on campus which was a short subway ride, so I started that. And that was before MBAs were so fashionable for physicians. Now there are a lot of physicians getting MBAs. I think it taught me a discipline that was useful in managing, and it certainly was useful when I became a department chair because I had a background most department chairs didn't have, at that time.
Dr. Gibbs: And it looks like your next step then was moving to New York and eventually, I guess, becoming the chairman there.
Dr. Davis: Yes, I'll tell you how that happened. When Simon retired they had a search committee, I was one of the candidates. Carl Mansfield was Simon's first resident, and he had gone to Kansas. I was coming to the point where I thought, gee, what am I going to do in the future? And I thought the next step would be to try to be a chair of a department. And when they selected Carl to be chair at Jefferson, I think Carl was looking for a proper role for me, and that would have really worked out. I said to him that I really thought it was time to be a chairman, so Marv Rottman, in New York, encouraged me to apply for the position at Montefiore and Einstein, which I did. And so I got selected for that chairmanship and that was a tough place. New York is a tough place. The people are tough and Charlie Botstein was in charge there before I came on, and his style was totally different than mine.
Dr. Gibbs: In what way was Charlie Botstein’s style different from yours?
Dr. Davis: Well, to some extent I think he enjoyed disorganization. I thought it was interesting because they didn't even schedule patients for follow ups and consults. The notion was that they would go in and write their name, and if it took five minutes it was fine. If it took two hours, then one of the physicians said the patients all understand when it's your turn you're going to get your attention. But when it's not your turn, you're just going to sit there and wait. Well, I tried to get a little more organized. The machines were scheduled. On the other hand, the equipment was really old, and I think Charlie Botstein enjoyed being the teacher. You know, the rooster with all his chicks running around behind him. If he would come into the department, the people who were there before would be following him even if they had other things to do.
Dr. Gibbs: So he remained in the department after you became chair?
Dr. Davis: Not officially. Montefiore is on one side of the Bronx and Einstein is on the other side of the Bronx. Charlie Botstein would only appear in the department if he knew I wasn’t there, if I were over on the Einstein campus. And, of course, he and Harold -- I can't remember his name -- no, it was the fellow who was over on the Einstein side. That was a diagnostic radiologist. They basically hated each other. I mean, the Einstein people sort of hated the Montefiore people so that they were really functioning as two different units. The compromise eventually was that the Montefiore would run the hospitals and Einstein was basically the medical school. And one thing I didn't like about it up there was that the dean felt that the basic science people were his, but the clinic people belonged over at Montefiore or even at Einstein hospital, which was part of Montefiore then. The dean acted like they weren't really his. And so that was bothersome. I think one tough thing about New York is New Yorkers as people are tough. New York is a busy place. There are people everywhere and I think that they have learned to survive because they're not bashful. And then it came to a point where it was sort of a tough thing to build that department because over on the Montefiore side they had a betatron which was non-functioning, and Charlie Botstein thought the betatrons were the most wonderful thing in the world. The accelerators were starting to replace the betatrons, even though at Jefferson there was a betatron. And so when I went up there, they had promised to replace some of the equipment. When I decided that we were going to get a linear accelerator to replace that betatron, Charlie Botstein made as much noise as he could about it, because he thought that was absolutely the wrong thing to do.
Dr. Gibbs: This is quite interesting.
Dr. Davis: But eventually that got replaced, and then we replaced two other accelerators. The rooms were incredibly small. There was not a lot of space up there, and then over on the Einstein side we replaced two machines. And the thing is over on the Einstein side. Before I came, those were two separate entities, and that made it one when I came up there. The fellow who was in charge over on the Einstein side went into private practice down in Manhattan. Gosein was his name. But there was a community hospital a mile and a half from Einstein where he maintained privileges, and they had a treatment machine. He was a real competitor on that side. Building that practice was always sort of a struggle. On the Montefiore side it was a little different. And there were two city hospitals that were part of that, too. Neither city hospital had radiation therapy equipment. North Central Bronx is attached to Montefiore. So if you had people in that hospital you were treating, that was easy. The one over on the Einstein side was across the street so that if there were hospital patients that you needed to see, it was a really long walk over there. And as I say, there were sort of continuing hostilities historically between those two. But we did put it together. They had a residency program that got shaped up when I went up there. The few residents they had in there were Russian immigrants, and we finally did sort of get that going very slowly.
Dr. Gibbs: It sounds like there were some strides made in a positive direction, during your tenure at Albert Einstein.
Dr. Davis: There was no doubt about it -- Einstein and Montefiore. We re-equipped it. And New York is a very regulated state on equipment, and they lost out on all the good financing because of their regulations. It was really hard to get equipment when Medicare would pay for it. And when they loosened their restrictions, Medicare wouldn't pay for it anymore. So if you wanted equipment, it was a real struggle because everything was hospital-based. And I do remember MRs were sort of coming in then, and they had one MR and it was a big deal. They had a new MR and I remember the fellow who was president of the hospital, the MR was busy -- you know? -- and you had to wait a while to get an appointment and he said there's no point in putting in another one because that was just going to cost money and people would still want more. So as a result, places were springing up around with imaging centers. But it was really tough to get anything in the hospital. And their attitude was that the in-patients made the money, and if radiation oncology didn't have much of an in-patient service, they were going to suffer when they had to do budget cuts. It didn't matter if you were busy with out-patients. Their view was the in-patient service was what made the money.
Dr. Phillips: What got you interested in going to Emory?
Dr. Davis: I always wanted to move south. We got tired of the cold weather up north, both Sally and I, and I had looked at Emory earlier. They had opened a search years before, and I went down and I was interviewed there. I really did have a real interest in moving south. I looked at a couple of positions and looked at one at the Medical College of Georgia and at Emory. And I thought there was a real opportunity at Emory. And when the dean offered me the position it was the best move I could have made because coming from New York, when I went down there and I saw radiology, they were crying that they didn't have enough equipment. But compared to New York they had a ton of equipment. They had four MRs, and they must have had four CT scanners and a bright shiny place. On the other hand, it was a strange situation because the practice was freestanding.
Dr. Phillips: The equipment was all freestanding also?
Dr. Davis: Yes. It's right there in the Emory Clinic, but the practice was freestanding and so we were total billers. And the attitude, at that time, was if you want a piece of equipment and you can pay for it, you buy it. The fellow in charge of the Emory Clinic said to me that they ran on a calendar year, and at the end of the calendar year they closed the books and any money in there had to be distributed. The few people down there like John McClaren were really making quite a bit of money. And they were going through the transition. They wanted the place to be more academic, but on the other hand they had these people there before under that policy. As long as I was chairman radiation oncology was considered freestanding.
Dr. Phillips: The hospital got none of the income.
Dr. Davis: No. None at all. None of the equipment was in the hospital. It's all over in the Emory Clinic which is attached to the hospital; you walk there through the tunnel or the bridge. You walk into the hospital, but nothing equipment-wise in radiation oncology is in the hospital.
Dr. Phillips: Was that the case at Penn early in the '60s? Did Pendergrass own all the equipment?
Dr. Davis: He did own the equipment, but I think by the time Dick Chamberlain took it over, I don't think that was the case. I think they had to strike some kind of deal where the hospital took it back. But I think that was the arrangement up there. I was never really privy much to the finances up at Penn.
Dr. Phillips: Did it eventually evolve into the hospital taking it over while you were at Emory?
Dr. Davis: I don't know. Now that Wally Curran is there, he struck some kind of deal because I think the hospital has taken over radiology pretty much, but radiation oncology was still separate. And I thought what Wally did to stave them off was to do some income sharing with them. But on the other hand, they have to do some equipment sharing on the purchases. I mean, it did come to the point even though it was still freestanding and we were earning that money, they sort of reorganized the place so that the fellow who was the chief financial officer for the hospital became the chief financial officer for the Emory Clinic, too. His view was if you couldn't justify a piece of equipment on the basis of a business plan, you couldn't buy it, even if you had money in the bank, because the Emory Clinic got into some financial troubles. Radiation oncology didn't because the money in radiation oncology was basically supporting the credit of the whole Emory Clinic. The financial officer was of the opinion you couldn't spend that money because they needed it for their credit. So while radiation oncology had the money in the bank, he wouldn't let you spend it. So you had to justify the equipment on the basis of the business plan. It got to be hard. If we wanted a new piece of equipment because it did IMRT and we said it would be better treatment, he didn't care whether it would be better treatment. He only cared dollars-and-cents-wise. But on the other hand if they would approve it, then you had to pay for it. You had to pay for it out of the department funds. That arrangement has changed some, but it still is sort of a unique situation.
Dr. Phillips: Well, Larry, could you tell us a little bit now about your involvement at the American Board of Radiology and the American College of Radiology? You have important positions there and contributed a lot. I wonder if you could tell us a little bit about that?
Dr. Davis: I got to be a trustee of the Board or Radiology, I think through the help of Simon Kramer. The Board of Radiology had six radiation oncology trustees. Three are nominated by ASTRO and three are nominated by the American Radium Society. Simon was president of the American Radium Society, and I did chat with him about my interest in becoming a member of the board. He had to send forward three nominees and then the trustees vote on the people who have been nominated. The cycle before, Bill Powers, I and somebody else were nominated. I didn't think Bill Powers was interested. At that point Bill was at Jefferson and he had an office right across the space from me, because we were both working on Patterns of Care. And Bill got elected and that shocked me, because I didn't know he was interested. On the other hand, the trustees on the Board of Radiology were Luther Brady, Sy Levitt, Juan del Regato, Bob Parker and Norah Tapley. Norah was given the assignment to tell me that I didn't get elected to the board. About a year or so later, Norah died and that opened up another spot, so Simon had me nominated again from the Radium Society. And since he saw how it worked, he had two other people nominated along with me that he didn't think were going to be acceptable to Luther Brady. Then they found me as the most acceptable of the candidates, so I got elected to the Board. Now at that time the Board's view was that you would examine not in your area of interest. So I was interested in head and neck tumors. They won't let you examine in your area of interest. Most of the job was the oral examination and, to some extent, helping to create the written exam. Terms on the Board at that time were six years, and you were eligible to be reelected once. I had the unexpired term of Norah Tapley to fill, which was about two years yet. And then I got elected for two terms of my own. And I enjoyed being with the Board, and it got bigger as time went on, because the Board got into more things. There was a lot of unhappy politicking within the Board, and some of that came about. The problem Sy Levitt had with the Board and how Luther approached that on trying to get that solved. And they had one assistant director. That was when Ken Kravanaugh was the executive director and he wanted to work with Jerry White. So for a long time Jerry White was the assistant executive director, and that went on for years. At some point -- and I think that was when Bob Parker was president of the board -- there was enough noise that radiation oncology was so separate from diagnostic radiology that they should have an assistant executive director for radiation oncology. And so I was proposed for that role right around the time my second full term was finishing. I got appointed for that. I mean, they had interviews and there might have been some other candidates, but I don't truthfully remember who they were.
Dr. Phillips: That's when the Board moved to Tucson?
Dr. Davis: Yes, the Board had already moved to Tucson. The Board got moved to Tucson because of Paul Capp. The Board had been moved, and Jerry White was still assistant executive director because they moved when Paul Capp replaced Ken Kravanaugh. I was doing things with regard to the Board, but Paul was never convinced that he couldn't do all the radiation oncology stuff, too. It came to the point that Bob Parker pushed it and Lester Peters, too. They decided that they would separate the administrative functions with two assistant executive directors. And while Paul was not pleased with it, he wasn't unaccepting of it either. I got appointed in that position, and I picked that up when I finished my second full term. I did some of it while I was still a trustee, and that had to do with the administrative things that the Board does now. Most of that could be done from my office. I didn't have to go to Tucson to do it because, in fact, after Bob Hattery took over the Board, he really felt I needed to come to Tucson quarterly, but there wasn't a lot to do. What I tried to do was to gather up the stuff that I would do in my office at Emory and do it in Tucson instead. It was a lot to review the written exam and to look at the material that they were getting for the oral exam. Those tended to be the kind of paperwork, reviewing all the applications for the examination. I continued that up until a couple years ago when my final term was up, because Steve Leibel was the one who negotiated the contract that ran until I left the Board. It didn't pay anything at all. I did it mostly because I thought it was important to do. Then they paid a little bit. We estimated that I was spending one day a week on the Board so it was sort of one-fifth of what they would pay for a visiting person at the Board office.
Dr. Gibbs: You had an impressive 30 years of commitment to the ABR.
Dr. Davis: It was a lot of time, because I even forgot how long I was there. When I stepped down, they gave me a little memento. That was 30 years. I thought, wow, that time went by quickly.
Dr. Gibbs: Well, good.
Dr. Phillips: Time goes fast when you're having fun.
Dr. Davis: Yes it does. It’s interesting because I was never quite so committed to the college. I worked in the college office all the years I was at Jefferson, and some afterwards.
Dr. Phillips: You got the Gold Medal from the college also.
Dr. Davis: Yes. I think that was interesting and I have to credit Steve Leibel for that, because in my mind I did far more for ASTRO than I ever did for the college, but I didn't get a Gold Medal from ASTRO. For the college, Steve wrote to Peter Johnstone at the place and said Larry needs the Gold Medal from the college. Would you nominate him? They nominated me, and Steve was on the board of the chancellors at the time. My guess would be maybe behind the scenes he orchestrated that, because I was shocked when I got that Gold Medal. Now I routinely go to the college meeting in May for the Gold Medal dinner. And I was on the board of chancellors for six years and I was on other committees for the college, too. And a lot of that for me was really boring because it was all diagnostic radiology, and diagnostic radiologists are all talking about diagnostic stuff, their billings and their politics. And radiation oncology was such a small part of it that there were times I had trouble staying awake in those meetings, even when I was on the board of chancellors. I never felt I was much of a contributor to it, because I didn't have a lot of interest in the issues of the diagnostic guys. I always felt we really should be far more separate, and the college was trying to keep it all together. And when I was on the board of chancellors, Frank Wilson was on. Frank was really a big pusher. We're one specialty and we need to be together, and he'd encourage college membership and I was never much onboard with that. I thought ASTRO should do it all, and I think ASTRO is pretty much doing it all now. I thought that was the appropriate thing. I thought that's what the radiation oncology community wanted. They didn't necessarily want the college to do it.
Dr. Phillips: Well, getting to your role in ASTRO, what were the most important things that came up while you were president and chairman of the board in terms of the development of ASTRO?
Dr. Davis: Well, I think there were two things. First of all, the finances were in real bad shape with ASTRO, and they've really turned that around. The second thing is that the meeting was getting bigger, and the year I was president was the last year that the meeting was in a hotel. We made the transition to the convention center. I thought those were two very positive moves. ASTRO wasn't into all these other things that they are in now. They weren't doing the lobbying or anything else like that, but that wasn't even on the agenda. ASTRO was small enough then, at least financially, that they couldn't nearly afford the staff. Things were pretty much being run by the college. The meeting-planning people were over there. ASTRO was just the annual meeting at that time.
Dr. Phillips: Do you think the direction that ASTRO has taken is good?
Dr. Davis: I think it is absolutely good because, radiation-oncology-wise, I think those people think of ASTRO as their organization. They are doing all these other meetings. I can't comment about those. I think it's probably the right thing to do. I think that's what the members want. And I've always had sort of a soft spot in my heart for the Radium Society. I thought it was a good meeting. It was small and, to some extent, I think they're getting squeezed out, but that's a different issue. But I think ASTRO is going in the right direction. And I see there are some proponents now. I see Anthony Zietman says that we need to be closer to diagnostic radiology. Well, maybe. See, I think it was interesting before. I do remember Doug Maynard who was chair at Bowman Gray. As far as he was concerned, radiation oncologists need some protection from the diagnostic radiologists. I never was of that view, but I think there was a view that the medical oncologists are going to gobble you up. But I think other specialties are after us, and I think ASTRO is the logical organization to try to stave that off.
Dr. Gibbs: I wanted to switch gears a little bit and talk about your family life. You had mentioned, I think, your wife Sally. When did you meet and under what circumstances?
Dr. Davis: Yes. This is my second marriage, and Sally worked for the College of Radiology. That's where I met her in Philadelphia. She is a Philadelphian, a long-time Philadelphian, and, to some extent, her heart is still in Philadelphia. While I was born and raised in Pittsburgh, my heart is in Atlanta now. I feel very much rooted here in Atlanta, but she still has a soft spot in her heart for Philadelphia. By her previous marriage, she has three children. Her daughter and one son have no children, and the other son has three children -- two boys and a girl. And they just graduated from college, and one is still in high school. I have a daughter who was in Florida. She’s married to a dermatologist, and she has triplets that are 16. But she's coming to the point that she has to worry about where they're going to go to school when they get out of high school. I'm glad I don't have to do that anymore.
Dr. Gibbs: You mentioned that Atlanta has been the area that you are really rooted and grounded in now. Are there particular hobbies that you enjoy?
Dr. Davis: I like baseball. I wish the Braves would do better. I still like football, but I like the Pittsburgh Steelers. I don't follow the Falcons even though they did pretty well, not as well as San Francisco, but they did pretty well. And we live on a golf course. I'd like to learn to play golf. I do go out, but everything is a practice round for me. There are things that occupy my time. If I go out on the golf course, I like to get the first tee time, so I won’t be held up by people in front of me, and I don't like people behind me either. I just like to go out and have a little fun. So I'll probably start doing that again. And we have tickets to the Atlanta Symphony. I like that, too. I like the classical music. I like opera, too, and the Atlanta opera is okay. Sally isn't so taken with opera. When we were up in New York, we had tickets for the Met and she thought that the best part of that was the dinner that went with the opera. There are certain operas I like, but I don't have a broad taste in that. And we both like ballet. Ballet in Atlanta is not so great. And for a long time even after we left New York, we had tickets to the New York City Ballet and the American Ballet Theater. But we got tired of running up to New York for the ballet, so we've sort of given that up. I think in the South the better ballet is in Miami. But that's not such an easy trek either.
Dr. Phillips: Did you ever do Sabbaticals, Larry, or visiting professorships that were memorable?
Dr. Davis: No. Never did a Sabbatical. A Sabbatical was not part of the opportunity down here. And I never did a lot of teaching, so I didn't do much in the way of visiting professorships. I got caught up with other things. I got caught up with building the department. At Emory I was caught up with the Board of Radiology, and I let the academics slide. Which was a pity. When I retired, I was probably one of the busier practitioners in the department. I was doing head, neck and breast. And since then, Emory head and neck is really a very good service, and we recruited somebody who fits right in with that group and is doing well.
Dr. Phillips: Do you have any reflections on your career? Anything you would have rather done differently than what you did do?
Dr. Davis: Yes. If I wasn't in such a panic to get on with my education, I would have done an MD/PhD program. I do have regrets about that. It would have been nice to do a PhD because I think it gives you discipline in your thinking and discipline in your research. It probably would have gotten me more caught up in publications and writing, things of that sort. Because I always looked on writing as being a real chore, so I didn't write so much. And I don't know that it would have helped me with the notion of teaching. If I had it to do over again, I might have made some other choices coming out of medical school of where I would have done my training. But if that had happened, I wouldn't have gone into radiation oncology and I think that was the right choice. I guess the only thing is really the PhD thing.
Dr. Gibbs: Since you've really navigated a number of situations, sometimes not entering them under rosy circumstances. In some situations you were able to affect some degree of change during your time, whether it be on the board or whether as a chairman. If you were to speak to an incoming department chairman now, what insights or leadership principles would you share with them?
Dr. Davis: I would tell them that you can't be very dogmatic. I think you have to look around and identify how you get the job done and establish relationships with people at the institution that are going to help you do that. I remember one time way back when I was a young puppy, I was at a cocktail party for one of the organizations, and Luther Brady was there. He said if you get involved with an organization, you have to look around and see how people move up in the organization. Then you need to work at that. I guess that is good advice. You can't just hop in and say I'm just going to do things. You need to take a minute and look around, see how the organization works and see how you're going to have the biggest influence with people and getting your job done by volunteering for things that they find useful. Down at Emory I got along very well with the financial people and the administrative people who helped me find space. The department was successful financially, so I was able to establish four endowed chairs in the department. In fact, the chair that Wally Curran occupies is named for me. The medical school had my name put on it with the consent of the department so that he's in that. There's a clinical endowed chair, a physics endowed chair and a biology endowed chair, because Mike Johns, who was the vice president for health affairs, said you need to put money aside to take care of the future of the department. And we had started doing that, and the fact that he endorsed that meant that the finance people in the Emory Clinic would let us move money over into the medical school where we could establish those endowed chairs. So I thought that was good advice.
Dr. Phillips: Do you have any favorite sayings?
Dr. Davis: No. Sorry, I wish I did. I'm a reader. I'm not a reader of good literature. I'm a reader of the fiction on The New York Times Best Seller List because it is a total distraction. On the one hand, it doesn't have all these wonderful sayings that the real literature does which Sally reads. She likes to read things that are more literature.
Dr. Gibbs: What would you say is your most important accomplishment that you're most proud of?
Dr. Davis: I think building the department at Emory. I was the first chair. They created the department when I came, and I think building that department is the thing I'm most proud of. I built the department, recruited the clinical staff, the physics staff, the biology staff. We established the residency program. It's one of the bigger programs now. They're approved for 16 residents. So I think I look on that as my accomplishment.
Dr. Phillips: Well, Larry, thank you so much. It's been a great interview.
Dr. Davis: Thank you for thinking of me to do it.
